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Long-term treatment of osteoarthritis of the knee “Foot orthoses can positively influence osteoarthritis”

Issue 01/2020

Bad Steben, Dr. med. Bertram Geigner

In the opinion of Dr. med. Bertram Geigner, Medical Director at Bad Steben Rehabilitation Center, Germany, orthopedic foot orthoses play an important role in the conservative treatment of osteoarthritis of the knee. During our interview, the specialist in orthopedics and trauma surgery explains how they can help balance muscle structures and reduce pain.

Bauerfeind life: How many osteoarthritis patients do you treat each year at Bad Steben Rehabilitation Center, and which osteoarthritis problems does this mainly include?

Dr. Bertram Geigner: Around 5,500 patients annually undergo rehabilitation. About a third is affected by osteoarthritic changes. This mainly includes osteoarthritis of the knee and hip. When it comes to osteoarthritis of the knee, the medial side is most frequently affected, and of that , stages 3 and 4 are most common. This means these patients are suffering from severe conditions. However, not every kind of osteoarthritis must be symptomatic. There are patients with stage 4 osteoarthritis who don’t feel any pain.

Dr. med. Bertram Geigner betrachtet den Fuß in erster Linie als sensomotorische Einheit.
First and foremost , Dr. med. Bertram Geigner sees the foot as a sensorimotor unit.

What does a patient’s long-term treatment of osteoarthritis of the knee consist of?

Dr. Bertram Geigner: Primarily, we’re always trying to treat conservatively and make sure the long-term treatment of osteoarthritis of the knee is adapted to individual requirements, whilst also considering the whole patient. We recommend a healthy diet focused on minimizing inflammatory processes. At the same time, we’re checking that patients control their weight carefully. Even five kilograms overweight doubles the risk of developing osteoarthritis of the knee. Another crucial component of treatment is muscle training. The goal is to develop the muscles guiding the knee, including the foot muscles. Knee orthoses as well as treating the feet with orthopedic foot orthoses are important elements, in particular when it comes to pain reduction. But also therapies such as intra-articular injections can additionally reduce pain and improve smooth movement of the knee. And osteoarthritis always requires activity. In addition to muscle guidance, it’s also essential for joint metabolism.

Why is being active so important?

Dr. Bertram Geigner: From the age of 25, cartilage no longer has its own nutrient supply. That means it is only supplied by diffusion of nutrients in the synovial fluid. The same applies to the removal of active substances that damage the cartilage. This diffusion is positively influenced by traction and compression, but also by shearing forces. The latter are only exerted during relevant movements. Therefore, meaningful activity – including movement therapy – are one of the most important pillars in conservative osteoarthritis treatment.

 

 

“It’s about transferring static loads from the foot to the knee with the perfect balance, using foot orthoses.”Dr. med. Bertram Geigner

How can orthopedic foot orthoses contribute to reducing strain on joint areas affected by osteoarthritis and therefore alleviate pain?

Dr. Bertram Geigner: Foot orthoses can positively influence osteoarthritis and alleviate problems. With osteoarthritis of the knee, in particular, when combined with foot problems, orthopedic foot orthoses can effectively reduce pain and therefore help patients assume the right movement habits. Ultimately, it’s about aligning the foot with the help of the foot orthosis in such a way that the muscles can be in the appropriate physiological pulling direction, and static loads are transferred from the foot to the knee with the perfect balance. This correction of the muscles has a positive effect on the proximal structures. I recommend supporting foot orthoses to my patients, especially during strain, for example when standing for a long time or walking on hard surfaces. Sufficient cushioning is also important here. It reduces excessive strain that has a negative impact on the knee but also on the ankle and small foot joints. Modified sensory feedback for the foot is expected from foot orthoses, but also from shoes. This leads to a modified neuromuscular response and changes muscle activities. It’s important that foot orthoses are always a part of an overall concept for the treatment of osteoarthritis of the knee. They can only result in improvement when combined with a conscious diet , muscle training and activity.

What effect do the foot orthoses have that you currently prescribe to your osteoarthritis patients?

Dr. Bertram Geigner: Usually, a prescription is based on a purely mechanical concept , for example, in the form of supporting foot orthoses for skew feet or cushioning foot orthoses against pressure pain. Our experience has shown that this can definitely be helpful. The foot , however, is not a static part of the body but , first and foremost , a sensorimotor unit. It needs stimuli and information it can transmit. This happens via neuromuscular feedback mechanisms that also have an impact on proximal structures such as the spine, hip and knee joints, but also muscular and fascial structures. This interaction has particular significance for the knee and lower leg, which are directly connected to the foot and its structures through muscles and fascia. The perfect solution would therefore be a foot orthosis combining supportive cushioning and sensorimotor effect , resulting in correction but also targeting muscles. All types of foot orthosis have an influence on the knee, knee pain and knee stabilization. As a basic rule, we’re always trying the best for the patient. The effect that foot orthoses can ultimately achieve completely depends on the patient’s individual symptoms. We have observed, however, that particularly those patients who watch their diet and weight , who exercise appropriately and also wear corresponding foot orthoses, can handle their condition very well long-term – without the need for invasive procedures. The best chances for success are ultimately offered by a combination of all measures, coupled with the patient’s own efforts.

Images: Frank Steinhorst


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